Dental tourism: grin or grimace?

International travel for dental care is a booming industry. In this blogpost KCL MSc graduate Carla Maran uses the example of Los Algodones in Mexico to argue that the growth of travel to ‘low-cost’ healthcare hubs prioritises the needs of visitors over those of local residents, drives inequalities and undermines global visions of a future ‘leaving no one behind’.

‘Molar City’

Twice each year the Mexican city of Los Algodones hosts a ‘Welcome Party’. Visitors get insights into local culture through live music and dance performances, with plenty of free food and drinks on offer. The event is described in a fascinating recent doctoral dissertation by Krystyna Adams (2018) – it is not simply a cultural festival but rather a marketing event to promote the city’s self-proclaimed reputation as ‘Dental Capital of the World’. Los Algodones – or ‘Molar City’ as it is sometimes referred – is reportedly home to the most dentists per capita globally (Kaufmann, 2013). The town boasts a highly concentrated grouping of about 500 dentists across four blocks (Adams, 2017). Its lavish biannual Welcome Party is an important sales event for these dental practitioners, who largely cater to cross-border travellers from the US. English-language services are widely offered and advertisements emphasise the good quality but cheap care: fees for treatments such as fillings, bridgework and crowns in Mexico can be found for two-thirds lower than prices charged in the US. Many dental practices have stalls at the Welcome Party event in the hope of attracting visitors who will go on to pay for dental treatment.

Globalised care

The growth of dental tourism is part of a wider trend across healthcare (Connell, 2016). Globally uneven distribution of providers and services, combined with large disparities in the costs of care, have stimulated global flows in care-seekers. This has been particularly concentrated in emerging economy countries, where low costs of labour, easing of investment regulations and immersion into global markets for trade in services, have fuelled rapid expansion of private healthcare infrastructure. Transnational healthcare users have been seen as an important source of capital in-flows for countries such as India and Turkey (Murray et al, 2016; Yilmaz, 2017), and now Mexico.

This growth of transnational care industries has been facilitated by technological advances. The growth of Internet technologies and cheap air travel allows people in wealthier countries to assess and book dental deals and treatments abroad (Turner, 2008: 553). Many use third-party facilitators to organise these visits, receiving advice not just on where to buy care but also on how to act, travel, eat and speak (Dalstrom, 2013).

Skewed priorities

The emergence of healthcare tourism hubs has come at a significant price, as the health needs of local residents have become secondary to commercial imperatives to serve tourists (Connell, 2016). In Los Algodones many local residents are being priced out of their own dental care system as service provision and fees are dictated by demand from US citizens (Adams, 2018: 111). Services are increasingly tailored towards restorative instead of preventative procedures, largely unaffordable for Los Algodones locals (Adams, 2017). Clinics increasingly focus on provision of cosmetic and modernised dental treatments such as laser teeth whitening, with US Dollars in cash the preferred method of payment, leaving local residents struggling to access basic dental services. This is exacerbated by the limited insurance coverage amongst residents: only 43% of Mexicans have state health insurance (Guerrero & Ricciardelli, 2018: 06:29).

Measures to compensate for the growth of the healthcare tourism industries have been limited and inadequate. In Los Algodones, some dentists claim to offer discounted services to locals, however this is focused during off-peak periods of demand from foreign patients (Adams, 2018: 111). Taxation of services would allow revenue to be re-invested into public health services for local residents, however this is made difficult by the emphasis placed on making payments in US Dollars cash. Further, there are indications of social division being reproduced through the outward-focused dental systems, as dentists describe local users as “bad patients” who arrive late for appointments and disrupt work schedules (Adams, 2018: 111).

Leaving no one behind?

The healthcare tourism industries emerging worldwide clearly offer a valuable in-flow of currency to local economies, but at what price? These growing industries are driving health inequity by distorting the availability of services to the detriment of local users. Limited financial protection from the costs of care is likely to perpetuate poverty cycles among local residents while reinforcing and exacerbating societal division. When 193 countries agreed to create the Sustainable Development Goals (SDGs), they specifically noted the need to ‘leave no one behind’. But by relegating the needs of local residents to a minor consideration, it appears healthcare tourism is in fact leaving many behind and will do little to accelerate progress towards SDG 3: to ‘ensure healthy lives and promote well-being for all at all ages’. Promoting healthy mouths will be particularly important for achieving the non-communicable disease target yet dental health is frequently considered a low priority for health policy-making. Much greater attention amongst researchers and the media is needed to identify the dental health needs of residents in healthcare tourism hubs, to ensure they are prioritised in future policy-making.